Provider Demographics
NPI:1700878329
Name:STRIEBEL, MARK HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:STRIEBEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3371 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2514
Mailing Address - Country:US
Mailing Address - Phone:937-458-4200
Mailing Address - Fax:937-458-4209
Practice Address - Street 1:3371 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2514
Practice Address - Country:US
Practice Address - Phone:937-458-4200
Practice Address - Fax:937-458-4209
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003471A207Q00000X
OH34-00-4194-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939240Medicaid
IN000000731793OtherANTHEM
OH0659023Medicaid
OHH414142Medicare PIN
IN000000731793OtherANTHEM
OH4216351Medicare PIN
IN200939240Medicaid